Falls are a major source of death and disability in the elderly and account for half of all accidental deaths for people 75 or older in the U.S. Preliminary research and review of the literature indicate that patients in nursing homes experience about 3,000 falls and 40 femoral fractures per 1,000 patient years. An epidemiologic investigation of contributing factors, costs, and prevention of fall injuries in nursing homes is proposed. Phase I will be a non-concurrent prospective study of one multilevel geriatric center (300 beds) to obtain details on the patient population and data on all falls during an 18-month period. Circumstances of falls and fall injuries will be analysed in relation to patient and environmental variables. Incidence rates for falls and fall injuries will be calculated by age, recency of admission, diagnosis, functional status, and other variables. On the basis of multiple logistic regression analysis, a predictive tool will be developed to identify the patients at greatest risk of falling and of being injured. Phase II, a prospective study in four institutions (1,200 beds), will test and perfect the predictive tool and further elucidate the factors that determine falls and fall injuries, especially femoral fractures, as well as their costs and sequelae. Of special interest in both Phase I and II will be the determinants of injury when a fall occurs, to which scant scientific attention has been given. Based on the results of the first two phases, Phase III will develop, apply, and evaluate interventions to reduce falls and fall injuries in high-risk patients. By identifying the patients at highest risk and the costs of their potential injuries, describing the key remediable factors, and evaluating intervention effectiveness, the study will stimulate the adoption of effective countermeasures to reduce fall injuries in longterm care facilities.